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29 Executive Briefing The Business of Optimizing Patients Prior to Surgery H ospitals are constantly looking for new ways to cut costs without compromising care quality. Ever so quick to target the operating room as an area to reduce expenses, hospitals tend to overlook the entire pre-operative patient optimization process in their improvement efforts far too frequently. The goal of optimizing patients prior to surgery is to prevent postoperative complications, decrease length of stay, reduce unplanned readmissions and enhance the patient's overall health and experience. Hospitals that truly optimize patients prior to surgery stand to gain a great deal in patient satisfac- tion, patient outcomes and financial reimbursement. "It's becoming increasingly important for hospitals to invest in their preadmission testing resources to help keep operational costs down while simultaneously improving outcomes. Not only has this helped with coordination and communication, but it has helped our clients capture what used to be missed revenue." said Dhir Desai, associate project manager with Surgical Directions. "If hospitals can optimize patients appro- priately, it can really help them get a handle on some of the financial pressures that payers are continuing to put in place." First things first, it's crucial to outline what optimizing pa- tients involves. What is optimization and what does it entail? There are many parts of optimization, but the first is determin- ing — based on what kind of surgery is scheduled — whether the hospital needs to do anything at all to optimize the patient, according to Sunil Eappen, MD, chairman of anesthesiology and the CMO at the Massachusetts Eye and Ear Infirmary in Boston, as well as assistant professor of anesthesiology at Bos- ton's Harvard Medical School. "That may sound kind of funny, but it's actually a very important question," he says. "If the hospital doesn't do this part properly, it could end up wasting the time of the patients, the energy of the clinicians and the money of the hospital on unnecessary lab tests and screenings." For instance, research suggests evaluating and optimizing patients who are undergoing eye surgery does not improve outcomes or reduce morbidity for the vast majority of cases. The second part of optimization is determining the best method to preoperatively screen patients, be it over the phone or as an in-person meeting. According to Dr. Eappen, more and more hospitals are trying to determine the best screening method based on data that already exists from patient-driven portals or provider-conducted interviews. "The hospitals that optimize patients best are very proto- col-driven. They have defined protocols for nearly every differ- ent kind of surgery and various patient criteria sets," says Dr. Eappen. "Using the same routines for every patient and giving every patient the same tests isn't efficient. The protocols should be driven by the likelihood of catching a problem that clini- cians can act on prior to surgery to reduce the patient's risk." The third part of optimization is establishing proper coordina- tion between all of the hospital's departments within periopera- tive services, according to Mr. Desai. "Coordination should include scheduling, pre-admission test- ing, nursing and anesthesia," says Mr. Desai. "Coordination is key to really moving the ball forward with optimizing patients appropriately, day by day." Optimization that falls short: Why it happens and why it's a problem Lack of coordination and a central command structure sur- rounding patient optimization drive inefficient and expensive perioperative hospital practices. Bringing all of the necessary Sponsored by: "If hospitals can optimize patients appropriately, it can really help them get a handle on some of the finanical pressures that payers are continuing to put in place."